The most important person in your practice probably makes less than the living wage

She answers the phone when you call about a symptom that is worrying you. She triages your concern before you ever see a doctor, coordinates your referral so it does not fall into a void, flags the lab result that needs attention before the end of the day, and manages the prescription renewal that keeps your blood pressure medication from lapsing. She keeps the schedule running, the paperwork flowing, and the physician focused on medicine instead of administration.She is, in every measurable sense, the person holding your healthcare experience together.But that is not the full picture of what she does. On any given day, the Medical Office Assistant at your family clinic is also:Managing serious conflict resolution—de-escalating distressed, frightened, or frustrated patients before they reach the physician. Coordinating care for children and the elderly, two of the most vulnerable and time-intensive patient populations in any practice. Administering and tracking vaccines, with the documentation and cold-chain compliance that entails. Cleaning and sterilizing clinical equipment between patients, every patient, every day. Managing confidential medical records with the legal and ethical weight that carries. Handling billing and accounting for a small medical business operating under complex provincial fee structures. Disposing of biological waste in compliance with health and safety regulations. Cleaning examination rooms between appointments to the standard a clinical environment demands.This is not a receptionist role. This is a highly skilled, multi-disciplinary position operating at the intersection of clinical care, patient safety, legal compliance and human service—often simultaneously, often under pressure, almost always without recognition proportionate to the responsibility.In Vancouver, she earns a median of approximately $22 an hour. PayScale puts the average even lower, around $19.65. The 2025 living wage for Metro Vancouver—the hourly rate a full-time worker needs to cover basic expenses, avoid chronic financial stress and participate meaningfully in their community—is $27.85. That is somewhere between $5 and $8 above what most MOAs actually earn, in the same city, doing this work.In a city where rent on a one-bedroom apartment exceeds $2,500 a month, these are not wages that attract experienced professionals. And they are not wages that keep them.Now consider the financial reality behind those wages.The 2025 Financial Review of Primary Care Clinics in Vancouver, produced by the Vancouver Division of Family Practice, found that the average Vancouver clinic spends roughly $51,000 per year on staffing per physician—approximately the cost of one full-time MOA. That one-to-one ratio of provider to support staff is what most clinics operate at, and it leaves almost no room for coverage during illness, vacation or the disruption of turnover.The same report found that the average breakeven overhead across Vancouver clinics is 22.4%. That is the point at which a clinic covers its costs and nothing more—no buffer, no contingency, no margin. At 25% overhead, one in five clinics would already operate at a loss. At 20%, nearly half would be in deficit.Think about what that means in practical terms. Most Vancouver primary care clinics are operating at a margin so thin that giving their MOA a raise to living wage—an increase of somewhere between $5 and $8 an hour—could push them into insolvency. Hiring one additional staff member to ease the load would, for many clinics, tip the balance entirely.This is not a staffing problem. It is a structural one.Our primary care system has been built, implicitly, on the assumption that the people doing this work can be paid below what it costs to live in the cities where they do it. That assumption is not just unfair. It is fragile. And the consequences of that fragility are already visible—in high turnover, in the institutional knowledge that walks out the door with every resignation, in the patient who has to re-explain their history to yet another new face, in the physician whose day becomes harder every time the team around them thins.When experienced MOAs leave—and at these wages, they do—what replaces them is someone newer, less trained, managing more complexity with less support. The vaccine schedule doesn't get simpler. The billing doesn't get less technical. The patient in conflict doesn't get less distressed. The biological waste doesn't manage itself. The standards don't lower to meet the capacity of an under-resourced team. The pressure simply accumulates, absorbed quietly by whoever is left.The cost of this is paid in multiple directions at once.For patients, it means erosion of the consistency and continuity that define quality primary care. Being known by your clinic—really known, by a team that remembers your history, your preferences, your family—is not a luxury. It is the mechanism by which early warning signs get caught, by which the right questions get asked, by which care actually feels like care rather than a transaction. Chronic understaffing and high turnover dismantle that mechanism quietly and persistently.For MOAs, it means building a career in a role of genuine clinical and administrative complexity, while being compensated as though the work is simple. The emotional labour alone—managing frightened patients, navigating difficult conversations, holding the emotional weight of people at their most vulnerable—is considerable and largely invisible in how the role is valued or paid.For physicians, it means that the quality of their working environment, their ability to focus on medicine, and the safety net that catches what would otherwise fall through the cracks, all depend on a support structure that the current economics make very difficult to sustain at the standard it deserves.And for the system as a whole, it means that the primary care infrastructure British Columbians depend on is being held together by people who cannot comfortably afford to live in the communities they serve—and by clinic owners whose margins are too thin to fix that without risking the clinic itself.This is something I feel strongly about. To my knowledge, our organization was among the first in Vancouver to offer all clinic staff full extended medical and dental benefits, as well as fully paid maternity leave. We made that decision because we believe the people who hold our clinics together deserve to be treated as professionals building a career, not as overhead to be minimized when margins tighten. The result has been exactly what you would expect: lower turnover, deeper institutional knowledge, stronger patient relationships and a team that cares about the work because the work cares about them.But sustaining that model requires a clinic to be financially viable enough to make it. And that is the part of this conversation that policy, recruitment culture and public perception have not yet caught up with.If we are serious about primary care in this province—about access, about quality, about keeping the clinics we have open and the ones we need viable—we have to be honest about the full cost of delivering it well. That cost includes paying the person who holds it all together a wage that reflects what she actually does.Because right now, we are asking her to do one of the most complex, consequential jobs in the health system. And we are asking her to do it for less than it costs to live here.That is not sustainable. And it is not right.(Sources: Financial Review of Primary Care Clinics in Vancouver, Vancouver Division of Family Practice, 2025; Living Wage BC, Metro Vancouver Living Wage, 2025; PayScale Vancouver MOA wages, 2025; Canada Job Bank BC, 2025).Dr. Julie Wilson in a family physician practicing in Richmond, B.C. She is also a clinical instructor at the University of British Columbia and CEO, founder and medical director of the Terra Nova Medical Centre.

The most important person in your practice probably makes less than the living wage

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